J Trauma
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Case Reports
Management of blunt injuries of the axillary artery and the neck of the humerus: case report.
Axillary artery injury, a rare vascular complication of fracture of the humeral neck, is rendered unique by the concomitant subluxation of the humeral head. A coordinated vascular and orthopaedic surgical approach is necessary to reconstruct both the shoulder joint and the artery. The operative techniques chosen may determine long-term outcome.
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Case Reports
Tangential low-velocity missile wound of the head with acute subdural hematoma: case report.
Tangential missile wounds of the head without skull fracture are a known entity. Usually, references in the literature indicate that this type of injury results from a high-velocity missile impact. ⋯ This possibility should be brought to the attention of clinicians as an essential element in this pre-treatment clinical evaluation. We propose a pathomechanical explanation for the development of the clinical state.
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Pigs were used for studies of effects on the peripheral nervous tissue of pressure waves induced by impact and passage through the left thigh of high-energy missiles. The short-lasting pressure waves were demonstrated to move close to the speed of sound and to have a spectrum of high frequencies and large amplitudes. The sciatic nerve in the contralateral leg showed no hemorrhage or major deformation. ⋯ Similar changes, although less extensive, were noticed in the phrenic nerves as well as in unmyelinated axons in both sciatic and phrenic nerves. It is concluded that a high-energy missile hit in the thigh of a pig, caused structurally demonstrable dislocations of myelin sheaths, and disarrangement of cytoskeleton and endoplasmic reticulum in axons as well as other signs of damage. The changes may interfere with the normal functions of peripheral and autonomic nerves.
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A retrospective review of 79 frostbite cases over a 10-year period at a major Northern Canadian hospital was performed. Factors predisposing to frostbite injury and predictors of a poor outcome were sought. ⋯ At the time of injury, 53% of patients were under the influence of alcohol and 16% were suffering from psychiatric illnesses. Lower extremity frostbite, infection, and delay in seeking medical attention were factors found to be associated with a poor outcome.
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Controversy continues regarding the use of PTFE versus autogenous vein grafts in the repair of arterial injuries. This study was designed to evaluate the results of a large series of autogenous interposition vein grafts used for arterial trauma. The charts of 191 patients with 192 arterial injuries repaired with an autogenous vein graft were reviewed. ⋯ Eighteen patients (9.4%) required amputation; however, only eight (4.2%) of these cases were graft related. One patient died from non-graft-related multiple organ failure, establishing a mortality rate of 0.5%. Based on the data reported in this series, it is concluded that autogenous grafts continue to provide a safe, readily accessible, and effective means by which selected arterial injuries can be repaired.